ABO incompatible blood transfusion

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UNOS Policy: ABO incompatible HTX for children up to 2 years (with acceptable isohaemoglutinin titres – less than 1:4)

Recipient Donor compatible Donor incompatible Antibodies to avoid Plasma / Platelets RBC
0 0 0
0 AB Anti AAnti B AB 0
0 A Anti A AB or A 0
0 B Anti B AB or B 0
A A
A 0
A AB Anti AAnti B AB A or 0
A B Anti AAnti B AB A or 0
B B
B 0
B AB Anti AAnti B AB B or 0
B A Anti AAnti B AB B or 0
AB AB AB
AB A AB
AB B AB
AB 0 AB

 


Preoperative preparation:

Isohaemagglutinin titres. Avoid transfusion. Consider transfusion in regards to guide.


Perioperative management:

If elevated iso-titre: plasma exchange once on CPB, iso-haemagglutinin quick test before AoCx release, repeat plasma exchange as required.


Postoperative management:

Isohaemaggluttinin titres daily of ABOi HTX. Repeat plasma exchange if required.


Outcome:

Similar long term outcome. Reduced rate of infection and rejection compared to ABO compatible blood transfusions.


References:

[1] Paediatric Heart Transplant Society: www.uab.edu/phts/

[2] Heart Lung Transplant. 2012 Feb;31(2):173-9: Henderson et al: ABO-incompatible heart transplantation: analysis of the Pediatric Heart Transplant Study (PHTS) database.


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Marc Anders is a paediatric intensivist.

Author: Marc Anders

Marc Anders is a paediatric intensivist.